Treatments and drugs

By Mayo Clinic Staff

What to do if you see someone having a heart attack

If you encounter someone who is unconscious from a presumed heart attack, call for emergency medical help. If you have received training in emergency procedures, begin cardiopulmonary resuscitation (CPR). This helps deliver oxygen to the body and brain.

According to guidelines by the American Heart Association, regardless of whether you've been trained, you should begin CPR with chest compressions. Press down about 2 inches (5 centimeters) on the person's chest for each compression at a rate of about 100 a minute. If you've been trained in CPR, check the person's airway and deliver rescue breaths after every 30 compressions. If you haven't been trained, continue doing only compressions until help arrives.

Heart attack treatment at a hospital

If you have a heart attack, your heart attack treatment at a hospital varies depending on the situation. You may be treated with medications, undergo an invasive procedure or both — depending on the severity of your condition and the amount of damage to your heart.

Medications

With each passing minute after a heart attack, more heart tissue loses oxygen and deteriorates or dies. The main way to prevent heart damage is to restore blood flow quickly.

Medications given to treat a heart attack include:

  • Aspirin. You may be instructed to take aspirin by the 911 operator, or you may be given aspirin by emergency medical personnel soon after they arrive. Aspirin reduces blood clotting, thus helping maintain blood flow through a narrowed artery.
  • Thrombolytics. These drugs, also called clotbusters, help dissolve a blood clot that's blocking blood flow to your heart. The earlier you receive a thrombolytic drug after a heart attack, the greater the chance you will survive and lessen the damage to your heart. However, if you are close to a hospital with a cardiac catheterization laboratory, you'll usually be treated with emergency angioplasty and stenting instead of thrombolytics. Clotbuster medications are generally used when it will take too long to get to a cardiac catheterization laboratory, such as in rural communities.
  • Superaspirins. Doctors in the emergency room may give you other drugs that are somewhat similar to aspirin to help prevent new clots from forming. These include medications, such as clopidogrel (Plavix) and others, called platelet aggregation inhibitors.
  • Other blood-thinning medications. You'll likely be given other medications, such as heparin, to make your blood less "sticky" and less likely to form more dangerous clots. Heparin is given intravenously or by an injection under your skin after a heart attack.
  • Pain relievers. If your chest pain or associated pain is great, you may receive a pain reliever, such as morphine, to reduce your discomfort.
  • Nitroglycerin. This medication, used to treat chest pain (angina), temporarily opens arterial blood vessels, improving blood flow to and from your heart.
  • Beta blockers. These medications help relax your heart muscle, slow your heartbeat and decrease blood pressure, making your heart's job easier. Beta blockers can limit the amount of heart muscle damage and prevent future heart attacks.
  • ACE inhibitors. These drugs lower blood pressure and reduce stress on the heart.
  • Cholesterol-lowering medications. Drugs called statins help lower levels of unwanted blood cholesterol and may be helpful if given soon after a heart attack to improve survival.

Surgical and other procedures

In addition to medications, you may undergo one of the following procedures to treat your heart attack:

  • Coronary angioplasty and stenting. Emergency angioplasty opens blocked coronary arteries, letting blood flow more freely to your heart. Doctors insert a long, thin tube (catheter) that's passed through an artery, usually in your leg or groin, to a blocked artery in your heart. This catheter is equipped with a special balloon. Once in position, the balloon is briefly inflated to open up a blocked coronary artery. At the same time, a metal mesh stent may be inserted into the artery to keep it open long term, restoring blood flow to the heart. Depending on your condition, your doctor may opt to place a stent coated with a slow-releasing medication to help keep your artery open.

    Coronary angioplasty is done at the same time as a coronary catheterization (angiogram), a procedure that doctors do first to locate narrowed arteries to the heart. When getting an angioplasty for heart attack treatment, the sooner the better to limit the damage to your heart.

  • Coronary artery bypass surgery. In some cases, doctors may perform emergency bypass surgery at the time of a heart attack. If possible, your doctor may suggest that you have bypass surgery after your heart has had time — about three to seven days — to recover from your heart attack.Bypass surgery involves sewing veins or arteries in place at a site beyond a blocked or narrowed coronary artery (bypassing the narrowed section), restoring blood flow to the heart.

Once blood flow to your heart is restored and your condition is stable after your heart attack, you may be hospitalized for observation.

May. 15, 2013